Faktor risiko kejadian berat bayi lahir rendah di RSUP Sanglah, Denpasar, Bali, Indonesia

Introduction: Maternal and child health has become a primary health focus in Indonesia and the maternal and child mortality rate in Indonesia is higher than those in South-East Asia countries. The incidence of Low Birth Weight (LBW) contributes to more than 50% of all neonatal mortality of all births in Indonesia. Therefore, identification of the risk factors that contributes to the incidence of LBW is important.

Method: This retrospective case-control study involved 50 cases of LBW and 50 controls (baby with normal birth-weight), The data were analyzed using SPSS version 22.

Result: The results of multivariate analysis showed that the factors significantly associated with LBW incidence were maternal blood pressure (p=0.000), history of giving birth to LBW babies (p=0.000), and the mode of current labor (p=0.034). The maternal age, maternal education level, maternal occupation, maternal anemia, parity, history of smoking, history of alcohol consumption, history of abortion, parity distance, and maternal BMI had no significant association (p>0.005).

Conclusion: Thus, the incidence of LBW can be prevented through maternal blood control during the pregnancy. Careful history taking of past history of giving birth to LBW babies and the mode of delivery must be done to reduce the incidence of LBW.

Pendahuluan: Kesehatan ibu dan anak merupakan salah satu fokus utama kesehatan di Indonesia. Kasus kematian ibu dan anak di Indonesia lebih tinggi dibandingkan dengan negara-negara di Asia Tenggara. Kejadian bayi berat lahir rendah (BBLR) berkontribusi terhadap lebih dari 50% total kematian neonatal di seluruh kelahiran di Indonesia. Oleh karena itu, identifikasi faktor-faktor risiko yang mendasari kejadian BBLR menjadi penting untuk dilakukan.

Metode: Penelitian kasus kontrol retrospektif ini melibatkan 50 kasus (BBLR) dan 50 kontrol (bayi lahir dengan berat badan normal. Data yang diperoleh kemudian dianalisis menggunakan perangkat SPSS versi 22.

Hasil: Hasil analisis multivariat didapatkan faktor-faktor yang memiliki hubungan signifikan dengan kejadian BBLR adalah tekanan darah ibu (p=0,000), riwayat melahirkan bayi BBLR (p=0,000), dan tipe persalinan bayi saat ini (p=0,034). Sebaliknya, faktor usia ibu, tingkat pendidikan ibu, pekerjaan ibu, anemia pada ibu, jumlah paritas, riwayat merokok, riwayat konsumsi alkohol, riwayat abortus, jarak paritas, dan IMT ibu tidak memiliki hubungan yang signifikan (p>0,005).

Simpulan: Pencegahan kejadian BBLR dapat dilakukan dengan mengontrol tekanan darah ibu selama kehamilan. Penggalian riwayat melahirkan bayi BBLR sebelumnya dan pemilihan metode persalinan juga harus dilakukan dengan seksama untuk mengurangi kejadian BBLR.

Hubungan antara rasio neutrofil limfosit dengan derajat klinis COVID-19 pada pasien anak di RSUD Tarakan provinsi Kalimantan Utara

Introduction: Coronavirus Disease-19 (COVID-19) is an outbreak that spread in early 2020 caused by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), this disease has a wide spectrum of symptoms from asymptomatic to severe respiratory symptoms. Neutrophil-lymphocyte ratio (NLR) is widely used as a marker of inflammation against viral infections, including SARS-CoV-2. This study was conducted to determine the relationship between NLR and the clinical degree of COVID-19 in pediatric patients at the Tarakan General Hospital in North Kalimantan Province.

Methods: A cross-sectional study was conducted on pediatric patients with COVID-19 infection who were treated in the COVID-19 isolation room at Tarakan Hospital, North Kalimantan for the period March 2020 – February 2021. There were 32 children who met the inclusion and exclusion criteria. Data on age, sex, body weight, neutrophil and lymphocyte counts, as well as the clinical degree of COVID-19 were collected from medical records. The NLR data was then categorized to NLR >3.13 or NLR <3.13 and searched for the relationship with the clinical degree of COVID-19. Spearman correlation test was used for bivariate analysis.

Results: The clinical degree of mild COVID-19 was found in 21 children (65.62%). NLR values in mild clinical grade were mostly increased (46.87%) than than which did not increase (21.87%).  All children with moderate clinical COVID-19 infection had RNL > 3.13 (18.74%).  In asymptomatic infection, no children having an increase in RNL (12.5%). The Spearman correlation test between NLR and the clinical degree of COVID-19 resulted in a correlation coefficient (r) = 0.758 (p < 0.001).

Conclusion: There is a strong relationship between the Neutrophil-Lymphocyte ratio and the clinical degree of COVID-19 in pediatric patients at Tarakan Hospital, North Kalimantan Province.

Pendahuluan: Coronavirus Disease-19 (COVID-19) adalah wabah yang menyebar pada awal 2020 disebabkan oleh virus Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), penyakit ini memiliki spektrum gejala yang luas dari asimptomatis hingga gejala respiratori yang berat. Rasio neutrofil-limfosit (RNL) banyak digunakan sebagai penanda inflamasi terhadap infeksi virus, termasuk SARS-CoV-2. Penelitian ini dilakukan untuk mengetahui besar hubungan antara RNL dengan derajat klinis COVID-19 pada pasien anak di Rumah Sakit Umum Daerah (RSUD) Tarakan Provinsi Kalimantan Utara.

Metode: Studi potong lintang dilakukan pada pasien anak dengan infeksi COVID-19 yang dirawat di ruang isolasi COVID-19 RSUD Tarakan Kalimantan Utara periode Maret 2020 – Febuari 2021. Terdapat 32 anak yang memenuhi kriteria inklusi dan eksklusi. Data mengenai usia, jenis kelamin, berat badan, jumlah hitung neutrofil dan limfosit, serta derajat klinis COVID-19 dikumpulkan dari rekam medis. Data RNL kemudian dikategorikan berdasarkan adanya peningkatan >3,13 atau tidak adanya peningkatan <3,13 dan dicari hubungan dengan derajat klinis COVID-19. Uji korelasi Spearman digunakan untuk analisis bivariat.

Hasil: Derajat klinis COVID-19 ringan ditemukan pada 21 anak (65,62%). Nilai RNL pada derajat klinis ringan sebagian besar meningkat (46,87%) daripada pada derajat klinis ringan dengan RNL yang tidak meningkat (21,87%). Semua anak yang mengalami infeksi COVID-19 dengan derajat klinis sedang memiliki RNL >3,13 (18,74%). Hal ini berbanding terbalik dengan derajat klinis asimtomatik, dengan semua anak tidak mengalami peningkatan RNL (12,5%). Uji korelasi Spearman antara RNL dengan derajat klinis COVID-19 menghasilkan koefisien korelasi (r) = 0,758 (p< 0,001).

Kesimpulan: Terdapat hubungan kuat antara rasio Neutrofil-Limfosit dengan derajat klinis COVID-19 pada pasien anak di RSUD Tarakan Provinsi Kalimantan Utara.

Gambaran anemia pada kehamilan trimester III di bagian obstetri dan ginekologi RSUD Waikabubak, Nusa Tenggara Timur periode 2019–2020

Background: Anemia is still a global public health problem. It is estimated that one third of women of childbearing age suffer from anemia and more than 40% of pregnant women suffer from anemia worldwide. Anemia in pregnancy can cause complications that affect both the mother and the fetus. This study aims to determine the description of anemia in the third trimester of pregnancy in the Obstetrics-Gynecology section of the Waikabubak Hospital during the 2019-2020 period.

Methods: A descriptive cross-sectional study on 355 pregnant women in the third trimester with anemia was conducted in the Obstetrics and Gynecology Section of Waikabubak Hospital for the period 1 July 2019 – 30 June 2020, who met the inclusion and exclusion criteria. Data were taken from the patient's medical record such as maternal age, gestational age, hemoglobin (Hb) level, erythrocyte index and pregnancy outcome. Data were analyzed with SPSS version 25 for Windows.

Results: The results of the examination of hemoglobin (Hb) levels showed that 49.58% of pregnant women in the third trimester at Waikabubak Hospital suffered from anemia. Based on the majority of respondents aged 20-35 years (76.62%), term (72.96%), moderate anemia (54.37%), microcytic hypochromic anemia (63.10%), and had an Appropriate for gestational Age (AGA) (83.98%) in pregnancy outcomes.

Conclusion: The third trimester pregnant women with anemia in Waikabubak Hospital mostly suffered at the age of 20-35 years, at term gestational age, with moderate degree of anemia, the most common type was microcytic hypochromic and with AGA pregnancy outcomes.

Latar Belakang: Anemia masih menjadi masalah kesehatan masyarakat global. Diperkirakan sepertiga wanita usia subur menderita anemia dan lebih dari 40% ibu hamil menderita anemia diseluruh dunia. Anemia dalam kehamilan dapat menyebabkan komplikasi yang berdampak pada ibu maupun janin. Penelitian ini bertujuan untuk mengetahui gambaran anemia pada kehamilan trimester III di bagian Obstetri–Ginekologi RSUD Waikabubak selama periode 2019-2020.

Metode: Penelitian deskriptif potong lintang pada 355 ibu hamil trimester III dengan anemia dilakukan pada Bagian Obstetri – Ginekologi RSUD Waikabubak periode 1 Juli 2019 – 30 Juni 2020, yang memenuhi kriteria inklusi dan eksklusi. Data yang diambil dari rekam medis pasien adalah usia ibu, usia kehamilan, kadar hemoglobin (Hb), indeks eritrosit dan luaran kehamilan. Data dianalisis dengan SPSS versi 25 untuk Windows.

Hasil: Hasil pemeriksaan kadar hemoglobin (Hb) didapatkan 49,58% ibu hamil trimester III di RSUD Waikabubak menderita anemia. Berdasarkan usia, sebagian besar responden  berusia 20-35 tahun (76,62%), aterm (72,96%), anemia sedang (54,37%), anemia hipokrom mikrositer (63,10%), dan memiliki luaran kehamilan Sedang Masa Kehamilan (SMK) (83,98%).

Simpulan: Ibu hamil trimester III dengan anemia di RSUD Waikabubak paling banyak diderita pada usia 20–35 tahun, pada usia kehamilan aterm, dengan derajat anemia sedang, tipe tersering hipokrom mikrositer dan dengan luaran kehamilan SMK.

Kesesuaian pewarnaan gram dengan kultur darah sebagai prediktor nilai kritis kasus bakteremia di Rumah Sakit Umum Pusat Sanglah, Denpasar

Background: One of the considerations for giving empiric antibiotics in bacteremia cases is gram staining (GS) results. Accurate and fast results are required in distinguishing infection-caused bacteria. However, the data on how much the corresponding gram stain results with bacterial growth in blood cultures are still insufficient.

Aim: The study aims to compare Gram stain results with bacterial growth in positive blood cultures.

Methods: A cross-sectional analytic study obtained data from the VITEK® 2 Compact (bioMérieux) results for six months (January - June 2020). Data involved all blood cultures examined as many as 509.

Results: Of the 509 blood samples, 46 were reported as critical values for bacteremia. Gram-negative bacillus bacteria were identified in 39.13% of the gram staining (GS) and 45.65% of the blood culture (BC) samples. Gram-positive bacteria appeared in 56.52% of GS and 52.17% of BC. MBRO (multidrug-resistant organisms) bacteria were identified in the proportion of 11%, then 13% from ESBL (extended-spectrum beta-lactamase) bacteria, and they remain as 4% MRSA (methicillin-resistant Staphylococcus aureus) bacteria. The higher result, 76% of the data was confirmed from the non-ICU patients.

Conclusion: GS can be used as a reference for empiric antibiotic therapy due to its effectiveness, and it has a high degree of similarity with positive blood culture results.

Latar belakang: Salah satu pertimbangan pemberian antibiotika empiris pada kasus bakteremia adalah berdasarkan hasil pewarnaan gram. Dibutuhkan hasil yang akurat dan cepat dalam membedakan bakteri penyebab infeksi. Namun sedikit data tentang berapa besar kesesuaian hasil pewarnaan gram dengan pertumbuhan bakteri pada kultur darah. Untuk membandingkan hasil pewarnaan gram dengan pertumbuhan bakteri pada kultur darah yang positif.

Metode: Penelitian ini merupakan penelitian analitik cross-sectional. Data diperoleh dari hasil VITEK^® 2 Compact (bioMérieux) selama enam bulan (Januari – Juni 2020). Sampel penelitian adalah semua kultur darah yang diperiksa pada periode penelitian berjumlah 509.

Hasil: Dari 509 sampel spesimen darah, 46 sampel dilaporkan sebagai nilai kritis prediktor bakteremia. Bakteri batang gram negatif teridentifikasi pada 39,13% sampel pewarnaan gram dan 45,65% sampel hasil kultur darah. Bakteri gram positif muncul pada 56,52% sampel pewarnaan gram dan 52,17% sampel hasil kultur darah. Bakteri MDRO (multidrug resistant organisms) teridentifikasi sebanyak 11%, 13% bakteri ESBL (extended spectrum beta lactamase), dan 4% bakteri MRSA (methicillin-resistant Staphylococcus aureus). Proporsi 76% sampel berasal dari pasien non-ICU.

Simpulan: Hasil pewarnaan gram dapat digunakan sebagai acuan terapi antibiotika empiris karena memiliki tingkat kesesuaian yang tinggi dengan hasil kultur darah positif.

Pengaruh lama paparan trauma listrik terhadap sistem saraf traktus gastrointestinal pada tikus Wistar galur murni

Background: Electrical trauma can cause injury to the body tissues it passes through, causing death. The injury is part of the process of cell damage, including the digestive organs. This study aims to determine the effect of the duration of electrical trauma on the nervous system of the gastrointestinal tract histopathologically.

Methods: This study was experimental with the research subjects were 24 pure strain Wistar rats, which were divided into 4 groups. The first group is the control group (K) without treatment. Then, group (X) was exposed to electricity for 15 seconds, group (Y) was given exposure for 30 seconds, and group (Z) was exposed to 60 seconds. From the preparations, the number of nerve cells was counted. Data were analyzed with SPSS version 20 for Windows.

Results: There was a significant effect on the duration of electrical trauma on the number of the gastrointestinal tract nervous system histopathologically (p<0.05). In the control group (K), the number of nerve cells for the stomach was 91.33±0.60, followed by the ileum (89.50±07.09), and colon (94.33±6.18). In group (X), the number of nerve cells in the stomach was 79.50±11.823, followed by the ileum (62.00±15.31), and colon (78.83±5.04). In group (Y), the number of nerve cells for gastric was 45.33±7.66, followed by ileum (34.00±16.27), and colon (47.17±9.56). Meanwhile, in the group (Z), the number of nerve cells for the stomach was 2.40±0.55, followed by the ileum (1.40±1.52), and colon (1.80±1.10). Thus, there was a significant difference between the study groups (p<0.001).

Conclusion: The duration of electrical trauma significantly affects the number of the gastrointestinal tract nervous system histopathologically.

Latar Belakang: Trauma listrik dapat menimbulkan perlukaan pada jaringan tubuh yang dilewatinya hingga menyebabkan kematian. Perlukaan tersebut merupakan bagian dari proses kerusakan sel, termasuk pada organ digestif. Penelitian ini bertujuan untuk mengetahui pengaruh lama paparan trauma listrik terhadap sistem saraf traktus gastrointestinal secara histopatologi.

Metode: Penelitian ini bersifat eksperimental dengan subyek penelitian adalah 24 ekor tikus Wistar galur murni, yang terbagi dalam 4 kelompok. Kelompok pertama merupakan kelompok kontrol (K) tanpa perlakuan. Kelompok (X) diberi paparan listrik selama 15 detik, kelompok (Y) diberi paparan selama 30 detik, dan kelompok (Z) diberi paparan selama 60 detik. Dari preparat, dilakukan penghitungan terhadap jumlah sel saraf. Data dianalisis dengan SPSS versi 20 untuk Windows.

Hasil: Terdapat pengaruh yang bermakna pada lama trauma listrik terhadap jumlah sistem saraf traktus gastrointestinal secara histopatologis (p<0,05). Pada kelompok kontrol (K), jumlah sel saraf untuk gaster adalah 91,33±0,60, diikuti dengan ileum (89,50±07,09), dan kolon (94,33±6,18). Pada kelompok (X), jumlah sel saraf pada gaster adalah 79,50±11,823, diikuti dengan ileum (62,00±15,31), dan kolon (78.83±5.04). Pada kelompok (Y), jumlah sel saraf untuk gaster adalah 45,33±7,66, diikuti dengan ileum (34,00±16,27), dan kolon (47,17±9,56). Sedangkan pada kelompok (Z), jumlah sel saraf untuk gaster adalah 2,40±0,55, diikuti dengan ileum (1,40±1,52), dan kolon (1,80±1,10). Didapatkan perbedaan bermakna  antara kelompok penelitian (p<0,001).

Kesimpulan: Lama trauma listrik memiliki pengaruh secara bermakna terhadap jumlah sistem saraf traktus gastrointestinal secara histopatologi.

Hubungan antara ekspresi c-MET dengan derajat diferensiasi histologi dan tingkat kedalaman invasi pada infiltrating urothelial carcinoma kandung kemih di RSUP Sanglah, Bali, Indonesia

Background: c-MET is a tyrosine kinase receptor that binds specifically to its ligand, namely hepatocyte growth factor (HGF). c-MET signaling deviations play a role in the progressivity of a wide variety of malignancies including bladder cancer. This study aims to determine the relationship between c-MET expression with the histological differentiation and depth of invasion in infiltrating urothelial carcinoma of bladder.

Methods: This study was a cross-sectional analytical study with 42 sample sizes. The samples were taken from a paraffin block of patients with infiltrating urothelial carcinoma of the bladder, that has performed resection and histopathological examination who were examined at the Anatomical Pathology Laboratory of Sanglah Hospital Denpasar from 2015-2020. The c-MET expression was examined by immunohistochemical staining of c-MET and evaluated using the H-score method. Data were analyzed using SPSS version 20 for Windows.

Results: Fisher's Exact test showed a statistically significant association between c-MET expression and the histological differentiation grade (p = 0.000). There was also a significant association between c-MET expression and depth of invasion with the Chi-Square test (p = 0.016), the Prevalence Ratio (PR) was 2.0 (95% CI = 1.2-3.6).

Conclusion: In conclusion, there is an association between c-MET expression with the histological differentiation grade and depth of invasion in the infiltrating urothelial carcinoma of bladder. High c-MET expression had twice the risk of developing advanced invasion.

Latar Belakang: c-MET merupakan reseptor tirosin kinase yang berikatan secara spesifik dengan ligannya, yaitu faktor pertumbuhan hepatosit (HGF). Penyimpangan c-MET signaling diketahui berperan dalam agresivitas berbagai macam keganasan termasuk kanker kandung kemih. Penelitian ini bertujuan untuk mengetahui hubungan antara ekspresi c-MET dengan derajat diferensiasi histologi dan tingkat kedalaman invasi pada infiltrating urothelial carcinoma kandung kemih.

Metode: Penelitian ini merupakan studi analitik potong lintang dengan besar sampel adalah 42, yang berasal dari blok parafin penderita infiltrating urothelial carcinoma kandung kemih yang diperiksa histopatologi di Laboratorium Patologi Anatomi RSUP Sanglah Denpasar dari 2015-2020. Ekspresi c-MET diperiksa dengan pengecatan imunohistokimia c-MET dan dievaluasi menggunakan metode H-score. Data dianalisis dengan SPSS versi 20 untuk Windows.

Hasil: Uji Fisher’s Exact menunjukkan hubungan yang bermakna secara statistik antara ekspresi c-MET dengan derajat diferensiasi histologi (p=0,000). Didapatkan juga hubungan yang bermakna antara ekspresi c-MET dengan tingkat kedalaman invasi dengan uji Chi-Square (p=0,016), prevalence ratio 2,0 (IK 95%=1,2-3,6).

Kesimpulan: Sebagai simpulan terdapat hubungan antara ekspresi c-MET dengan derajat diferensiasi histologi dan tingkat kedalaman invasi pada infiltrating urothelial carcinoma kandung kemih. Ekspresi c-MET tinggi memiliki risiko dua kali lebih besar mengalami invasi lanjut. c-MET diharapkan dapat menjadi faktor prognostik yang bermanfaat dalam penatalaksanaan infiltrating urothelial carcinoma kandung kemih.

Nilai rasio neutrofil-limfosit sebagai prediktor kasus COVID-19 serangan berat pada pasien dewasa

Background: The pandemic condition that has been experienced since 2020 due to Coronavirus Disease (COVID-19) is still a national and international problem that needs full attention with number of cases continues to grow over time. Most cases of COVID-19 are cases with mild clinical manifestation, but some of these mild cases might then worsen in a matter of days due to the widespread inflammatory process that occurs due to viral infection. The use of Neutrophil-Lymphocyte Ratio (NLR) values in general has been known for its function as a biomarker of systemic inflammatory status. Therefore, this study is expected to be able to predict the incidence of severe COVID-19 in adult patients in BRSUD Tabanan, Bali.

Methods: The study was conducted using secondary data from 137 adult COVID-19 patients at BRSUD Tabanan in June – December 2020. The sampling method used was consecutive sampling of all adult patients aged 18 years who had been diagnosed with COVID-19 and treated in the isolation room.

Results: There were 61 cases (44.5%) of severe COVID-19. Of 88 cases of COVID-19 with NLR > 3.3, 56 cases (63.6%) were classified as severe COVID-19 and of 49 cases of COVID-19 with NLR 3.3 only 5 cases (10.2%) were classified as severe COVID-19. Patients with NLR values > 3.3 were found to have 6.2 times as likely to suffer from severe COVID-19 than patients with 3.3 NLR values.

Conclusion: The NLR value as one of the easy and simple tests can be used to predict the incidence of severe COVID-19 in patients.

Pendahuluan: Kondisi pandemi yang telah dialami sejak tahun 2020 akibat Coronavirus Disease (COVID-19) masih merupakan masalah nasional dan internasional yang perlu perhatian penuh dengan jumlah kasus yang terus bertambah seiring berjalannya waktu. Sebagian besar kasus COVID-19 merupakan kasus dengan keluhan ringan namun tidak sedikit kasus ringan tersebut kemudian dapat mengalami perburukan dalam hitungan hari akibat proses inflamasi luas yang terjadi karena infeksi virus. Penggunaan nilai rasio neutrofil-limfosit atau Neutrofil-Lymphocyte Ratio (NLR) secara umum telah diketahui fungsinya sebagai biomarker status inflamasi sistemik. Oleh karena itu, melalui penelitian ini diharapkan mampu memprediksi kejadian COVID-19 serangan berat pada pasien dewasa di BRSUD Tabanan.

Metode: Penelitian ini merupakan penelitian observasional dengan rancang penelitian cross-sectional analitik menggunakan data sekunder dari 137 pasien dewasa COVID-19 di BRSUD Tabanan bulan Juni – Desember 2020. Metode sampling yang digunakan adalah consecutive sampling terhadap seluruh pasien dewasa usia ? 18 tahun yang telah terdiagnosis COVID-19 dan dirawat di ruang isolasi.

Hasil: Ditemukan sebanyak 61 kasus (44,5%) tergolong kasus COVID-19 serangan berat. Dari 88 kasus COVID-19 dengan NLR > 3,3 56 kasus (63,6%) tergolong kasus COVID-19 serangan berat dan dari 49 kasus COVID-19 dengan NLR ? 3,3 hanya 5 kasus (10,2%) tergolong kasus COVID-19 serangan berat. Pasien dengan nilai NLR > 3,3 ditemukan memiliki risiko 6,2 kali lebih besar menderita keluhan COVID-19 serangan berat dibandingkan pasien dengan nilai NLR ? 3,3.

Simpulan: Nilai NLR sebagai salah satu pemeriksaan mudah dan sederhana dapat digunakan untuk memprediksi lebih awal terjadinya COVID-19 serangan berat pada pasien.

Membedah peran bank sampah guna menilik efektivitas pengelolaan limbah medis B3 rumah sakit

Background: The implementation of the waste bank to reduce the cost of hazardous and toxic medical waste management needs to be optimized so that it is effective to reduce costs and additional hospital income.

Aim: The study aims to determine the factors causing the non-optimal management of medical waste at Surya Husadha Hospital through the implementation of the waste bank.

Methods: This study applied a qualitative approach with purposive sampling at Surya Husadha Hospital. Data were collected through observation, in-depth interviews and documentation from six informants.  

Result: Some obstacles cause the implementation of the waste bank at Surya Husadha Hospital in reducing medical waste management costs to be not optimal, such as limited human resources and equipment. This obstacle causes only two of the four types of medical waste according to the Regulation of the Minister of Environment and Forestry of the Republic of Indonesia No. 56 of 2015, which can be managed through waste banks such as used infusion bottles and used hemodialysis fluid packaging.

Conclusion: The implementation of the waste bank at Surya Husadha Hospital has met the proper regulation, but it is necessary to evaluate the constraints, and planning for the needs of human resource and equipment in reducing medical waste management costs.

Latar Belakang: Penerapan bank sampah dalam membantu beban biaya pengelolaan limbah medis bahan berbahaya dan beracun (B3) perlu lebih dioptimalkan sehingga bisa efektif untuk meringankan biaya sekaligus bisa sebagai pendapatan tambahan untuk rumah sakit.

Tujuan: Studi ini bertujuan untuk mengetahui faktor-faktor penyebab kurang optimalnya pengelolaan limbah medis B3 di Rumah Sakit Umum (RSU) Surya Husadha melalui pemberdayaan bank sampah.

Metode: Penelitian ini menggunakan pendekatan kualitatif dengan purposive sampling di RSU Surya Husadha. Teknik pengumpulan data yang dilakukan adalah melalui observasi, wawancara mendalam serta dokumentasi dari enam informan.

Hasil: Ditemukan adanya beberapa kendala yang menyebabkan penerapan bank sampah di RSU Surya Husadha dalam mengurangi beban biaya pengelolaan limbah medis B3 menjadi kurang optimal. Kendala tersebut berupa keterbatasan sumber daya manusia serta keterbatasan ketersediaan sarana prasarana. Adanya kendala tersebut menyebabkan dari empat jenis limbah medis B3 yang bisa dikelola melalui bank sampah sesuai Peraturan Menteri Lingkungan Hidup dan Kehutanan (LHK) RI No 56 Tahun 2015 hanya dua yang bisa dikelola yaitu botol infus bekas dan bekas kemasan cairan hemodialisis.

Kesimpulan: Pelaksanaan pengelolaan limbah medis B3 di RSU Surya Husadha sudah sesuai regulasi, namun evaluasi terhadap kendala-kendala, perencanaan kebutuhan tenaga, dan juga pengadaan sarana prasarana yang dibutuhkan dalam menunjang kegiatan bank Sampah sangat diperlukan untuk membantu mengurangi biaya pengelolaan limbah medis B3.

Hubungan antara ekspresi Vascular Cell Adhesion Molecule-1 (VCAM-1) dengan tipe dan stadium T karsinoma epitel permukaan ovarium di RSUP Sanglah, Bali, Indonesia

Background: Vascular Cell Adhesion Molecule-1 (VCAM-1) is an important protein in oncogenesis, angiogenesis, tumor development, and metastasis. Studies regarding the expression of VCAM-1 in ovarian carcinoma have found both supportive and contradictory results. Therefore, this study evaluates the relationship between VCAM-1 expression and the type and stage of ovarian surface epithelial carcinoma at Sanglah General Hospital, Bali, Indonesia.

Methods: This study was a cross-sectional analytical study with a sample size of 36, which came from paraffin block of patients with ovarian surface epithelial carcinoma who were examined histopathologically at the Anatomical Pathology Laboratory of Sanglah Hospital Denpasar from 1 January 2017 to 31 December 2019. Samples are grouped into type I and type II, then the stage I or II and III groups. After that, the VCAM-1 immunohistochemical streak was performed to assess high or low expression in these groups and analyzed its relationship with the type and stage T of ovarian surface epithelial carcinoma. Data were analyzed using SPSS version 25 for Windows.

Results: The analysis results using the Chi-Square test showed a statistically significant relationship (p=0.001) between the VCAM-1 expression with type and stage surface epithelial ovarian carcinoma (p=0.007). The results of the mean difference test are 0.48 (95% CI=0.33-0.70) and showed a statistically significant difference (p=0.001) between VCAM-1 expression with a type of ovarian carcinoma.

Conclusion: In conclusion, there is an association between expression VCAM-1 with the type of surface epithelial ovarian carcinoma and at a stage, with a 2.3 times higher probability of VCAM-1 expression in the stage III group than in stage I or II group.

Latar Belakang: Vascular Cell Adhesion Molecule-1 (VCAM-1) merupakan salah satu protein yang penting dalam onkogenesis, angiogenesis, perkembangan tumor dan metastasis. Penelitian-penelitian mengenai ekspresi VCAM-1 pada karsinoma ovarium mendapatkan hasil yang pro dan kontra. Oleh karena itu, penelitian ini bertujuan untuk mengetahui hubungan antara ekspresi VCAM-1 dengan tipe dan stadium T karsinoma epitel permukaan ovarium di RSUP Sanglah, Bali, Indonesia.

Metode: Penelitian ini merupakan studi analitik potong lintang dengan besar sampel adalah 36, yang berasal dari dari blok parafin penderita karsinoma epitel permukaan ovarium yang diperiksa secara histopatologi di Laboratorium Patologi Anatomi RSUP Sanglah Denpasar dari 1 Januari 2017 sampai 31 Desember 2019. Sampel dikelompokkan menjadi tipe I dan tipe II, kemudian kelompok stadium I atau II dan III. Setelah itu dilakukan pulasan imunohistokimia VCAM-1 untuk menilai ekspresi tinggi ataupun rendah pada kelompok-kelompok tersebut dan dianalisis hubungannya dengan tipe dan stadium  T karsinoma epitel permukaan ovarium. Data dianalisis dengan uji Chi-Square dengan nilai p <0,05.

Hasil: Hasil penelitian menunjukkan terdapat hubungan yang bermakna secara statistik (p=0,001) antara ekpresi VCAM-1 dengan tipe karsinoma dan stadium T (p=0,007). Hasil uji beda rerata adalah 0,48 (IK 95%=0,33-0,70) dan menunjukkan perbedaan bermakna secara statistik (p=0,001) antara ekspresi VCAM-1 dengan tipe karsinoma ovarium.

Kesimpulan: Sebagai simpulan, terdapat hubungan antara ekspresi VCAM-1 dengan tipe karsinoma epitel permukaan ovarium dan pada stadium, dengan kemungkinan 2,3 kali terjadi ekspresi VCAM-1 yang tinggi pada kelompok stadium III dibandingkan stadium I atau II. 

Gelombang Brainstem Evoked Response Audiometry (BERA) pada anak di bawah lima tahun dengan keterlambatan bicara dan bahasa disertai gangguan pendengaran di RSUP Sanglah, Bali, Indonesia

Background: Hearing loss is one factor that influences speech and language development in children, especially in the first five years of life. The detection of hearing loss in a child can be done with an objective Brainstem Evoked Response Audiometry (BERA). This study aims to evaluate the value of BERA waves in children under five with speech and language delays at the ENT outpatient clinic of Sanglah General Hospital Denpasar.

Methods: This study is a retrospective descriptive study design by taking secondary data from the medical records of patients with speech and language delays accompanied by hearing loss who were subjected to BERA examination. Samples were taken by consecutive sampling. Data analysis in this study consisted of descriptive statistical analysis, independent T test, and one-way ANOVA. Data were analyzed using SPSS version 24 for Windows.

Results: This study involved 65 people as a sample. Based on gender, it was found that male (76.9%) was more than female (23.1%). Most of them were aged 24-35 months (43.1%). The most hearing loss was Moderate SNHL on the right ear (38.5%), while Mild SNHL on the left ear (38.5%). The mean latency time between I-V waves in the left ear of boys was longer, that was 4.96 ms with a variation of 0.56 ms, compared to 4.59 ms for girls with a deviation of 0.64 ms. There was a significant difference in the mean latency between waves I-V of the left ear between male and female toddlers (p=0.033).

Conclusion: Based on the research, it was found that the absolute latency time and between waves of BERA on the right ear did not have a significant difference in boys and girls, but on the left ear, there was a statistically significant difference in the mean of latency time between waves IV in boys and girls.

Latar Belakang: Gangguan pendengaran merupakan salah satu faktor yang mempengaruhi perkembangan bicara dan bahasa pada anak terutama pada lima tahun pertama kehidupan. Deteksi gangguan pendengaran pada seorang anak dapat dilakukan dengan pemeriksaan Brainstem Evoked Response Audiometry (BERA) yang objektif. Penelitian ini bertujuan untuk melihat nilai gelombang BERA pada anak balita dengan keterlambatan bicara dan bahasa di Poliklinik THTKL RSUP Sanglah Denpasar.

Metode: Penelitian ini menggunakan rancangan penelitian deskriptif retrospektif dengan mengambil data sekunder dari catatan medis pasien keterlambatan bicara dan bahasa disertai gangguan pendengaran yang dilakukan pemeriksaan BERA. Sampel diambil dengan cara consecutive sampling. Analisis data pada penelitian ini terdiri dari analisis statistik deskriptif, uji T independen, dan one way ANOVA. Data dianalisis dengan SPSS versi 24 untuk Windows.

Hasil: Penelitian ini melibatkan 65 orang sebagai sampel. Berdasarkan jenis kelamin didapatkan jenis kelamin laki-laki (76,9%) lebih banyak dari perempuan (23,1%). Usia terbanyak pada usia 24-35 bulan (43,1%). Gangguan pendengaran paling banyak yaitu SNHL Sedang pada telinga kanan (38,5%), sedangkan pada telinga kiri SNHL Ringan (38,5%).  Rerata masa laten antar gelombang I-V pada telinga kiri balita laki-laki lebih panjang yaitu 4,96 ms dengan variasi 0,56 ms, dibandingkan balita perempuan 4,59 ms dengan variasi 0,64 ms. Terdapat perbedaan bermakna rerata masa laten antar gelombang I-V telinga kiri antara balita laki-laki dan perempuan (p=0,033).

Simpulan: Berdasarkan penelitian didapatkan bahwa masa laten absolut dan antar gelombang BERA pada telinga kanan tidak ada perbedaan bermakna pada balita laki-laki dan perempuan, namun pada telinga kiri secara statistik terdapat perbedaan bermakna rerata masa laten antar gelombang I-V pada balita laki-laki dengan perempuan.

Neutrophil-Lymphocyte Ratio (NLR) as an output-outcome predictor in moderate-severe head injury at Sanglah General Hospital, Denpasar, Indonesia

Background: This prospective cohort study aims to determine the best cut point value and the ability to predict Neutrophil Lymphocyte Ratio (NLR), analyze the most dominant factors, and the direct influence of the NLR to output and outcome in moderate and severe trauma to the head injury at Sanglah General Hospital, Denpasar, Indonesia.

Methods: This study was an observational analytic with a prospective cohort design. The subjects of this study were head injury patients over 16 years old with Glasgow Coma Scale (GCS) ? 12 who visited and were treated at Sanglah General Hospital, Denpasar, Indonesia. Patients less than 16 years old, history of alcohol intoxication, stroke, metabolic disease, and multiple traumas were not included as research subjects. Data were analyzed using SPSS version 20 for Windows.

Results: The research conducted on 49 respondents found that the best cut-off point of NLR was 6.05 has the most significant predictor (OR=7.6; p=0.001) and dominant (OR=64.97; p=0.002) factors to the output-outcome predictor in moderate-severe head injury. In addition, this cut-off value (6.05) also has a direct influence (x-value=0.523) in the occurrence of output and outcome unfavorable in moderate-severe head injury.

Conclusion: the cut-off NLR values of 6.05 became the dominant predictor that directly affected the output and outcome unfavorable in moderate-severe head injury.

Efek ekstrak sambiloto (Andrographis paniculata) terhadap ekspresi matrix metalloproteinase-1 dan hipertrofi jantung pada mencit yang terpapar asap rokok

Introduction: Sambiloto (Andrographis paniculata) is a plant that is often used in traditional medicine and is known to have antioxidant, anti-inflammatory and cardiovascular effects. There are many studies of sambiloto on inflammatory markers, but there is no study on the effect of sambiloto on MMP-1 expression. The purpose of this study was to determine the effect of sambiloto on MMP-1 expression and cardiac hypertrophy in mice exposed to cigarette smoke.

Methods: This research is an experimental analytic study with a randomized post test only control group design. Thirty-two healthy male Swiss Webster mice aged 8-10 weeks weighing 20-30 grams were divided into 4 groups, namely: control group (standard feed + exposure to cigarette smoke), P1 (standard feed + exposure to cigarette smoke + sambiloto extract 18 mg/ kg BW), P2 (standard feed + exposure to cigarette smoke + sambiloto extract 29 mg/kg BW), P3 (standard feed + exposure to cigarette smoke + sambiloto extract 40 mg/kg BW). All groups were followed for 60 days.

Results: There was a significant difference in MMP-1 expression between the control group and all treatment groups. There were significant differences in MMP-1 expression between groups P1 and P2, and between P1 and P3 groups. There was a significant difference in heart weight/weight ratio between the control group and all treatment groups. There was a significant difference in the heart weight/body weight ratio between the P1 and P3 groups.

Conclusion: The administration of sambiloto extract decreased the expression of MMP-1 with a tendency for its effect to increase with increasing dose and the optimal dose was found in the sambiloto extract 29 mg/kg BW. The difference in the effect of sambiloto extract on cardiac hypertrophy only appeared after the dose was increased to 40 mg/kg BW

Latar Belakang: Sambiloto (Andrographis paniculata) merupakan tanaman yang sering dipakai dalam pengobatan tradisional dan diketahui mempunyai efek antioksidan, anti inflamasi dan efek pada sistem kardiovaskular. Terdapat banyak penelitian sambiloto terhadap marker inflamasi, tetapi belum ada penelitian tentang efek ekstrak sambiloto terhadap ekspresi MMP-1. Tujuan dari penelitian ini untuk mengetahui efek ekstrak sambiloto terhadap ekspresi MMP-1 dan hipertrofi jantung pada mencit yang terpapar asap rokok.

Metode: Penelitian ini adalah penelitian analitik eksperimental dengan rancangan randomized post test only control group design. Tiga puluh dua mencit Swiss Webster jantan sehat berumur 8-10 minggu dengan berat 20-30 gram dibagi menjadi 4 kelompok yaitu: kelompok kontrol (pakan standar + paparan asap rokok), P1 (pakan standar + paparan asap rokok + ekstrak sambiloto 18 mg/kg BB), P2 (pakan standar + paparan asap rokok + ekstrak sambiloto 29 mg/kg BB), P3 (pakan standar + paparan asap rokok + ekstrak sambiloto 40 mg/kg BB). Semua kelompok diikuti selama 60 hari.

Hasil: Terdapat perbedaan signifikan ekspresi MMP-1 antara kelompok kontrol dengan semua kelompok perlakuan. Terdapat perbedaan signifikan ekspresi MMP-1 antara kelompok P1 dengan P2, dan antara P1 dengan P3. Terdapat perbedaan signifikan rasio berat jantung/berat badan antara kelompok kontrol dengan semua kelompok perlakuan. Terdapat perbedaan signifikan rasio berat jantung/berat badan antara kelompok P1 dengan P3.

Simpulan: Pemberian ekstrak sambiloto menurunkan ekspresi MMP-1 dengan kecenderungan efeknya meningkat dengan peningkatan dosis dan dosis optimal terdapat pada ekstrak sambiloto 29 mg/kg BB. Perbedaan efek ekstrak sambiloto terhadap hipertrofi jantung baru muncul setelah dosis ditingkatkan menjadi 40 mg/kg BB.  

Hubungan Lymph Vessel Density (LVD) dengan invasi limfatik dan metastasis kelenjar getah bening regional pada karsinoma payudara invasif tipe tidak spesifik di RSUP Sanglah, Bali, Indonesia

Background: Lymph Node Metastasis (LNM) is considered the most important prognostic factor in breast cancer. The progress of lymphatic metastasis is thought to involve the proliferation of lymphatic vessels (lymphangiogenesis), Lymph Vessel Invasion (LVI), and lymph node metastasis step by step. This study aims to evaluate the association between LVD with LVI and regional LNM in invasive breast carcinoma of no special type.

Methods: This study used a cross-sectional analytical study, using a sample of 38 paraffin-embedded tissue from the patient with invasive breast carcinoma of no special type in Sanglah General Hospital, Bali, Indonesia, in 2018. The sample will be used to assess LVD and LVI by D2-40 immunohistochemistry. Expression of D2-40 with vigorous-intensity was evaluated on the membrane and cytoplasm of lymphatic endothelial cells to determine the definition of lymphatic vessels. Lymph vessel density was determined by counting the number of lumens of peritumoral lymphatic vessels in five fields of view with the densest lymphatic vessel lumen using a Leica microscope (DM750, 400x, area 0.225mm2). Data were analyzed using SPSS version 24 for Windows.

Results: The LVD cut-off value is 16.5 lymphatic vessel lumens/0.225 mm2 (65.4% for sensitivity and area Under the Curve (AUC)=70.2%). Then cases were classified into the category of high LVD (?16,5 lymphatic vessel lumen/0,225 mm²) and low LVD (<16.5 lymphatic vessels lumen/0,225 mm²). The study found a statistically significant association between LVD and lymph vessel invasion (PR=3.6; p=0.043; 95%CI=0.88-14.78) and regional lymph node metastases (PR =1.7; p=0.02; 95%CI=1.03-2.79).

Conclusion: This study proved an association between LVD with lymph vessel invasion and regional lymph node metastases. 

Latar Belakang: Metastasis Kelenjar Getah Bening (KGB) dianggap sebagai faktor prognostik yang paling penting pada kanker payudara. Perkembangan metastasis limfatik diduga melibatkan proliferasi pembuluh limfatik (limfangiogenesis), Lymph Vessel Invasion (LVI) atau invasi limfatik, dan metastasis kelenjar getah bening secara bertahap. Penelitian ini bertujuan untuk mengevaluasi hubungan antara Lymph Vessel Density (LVD) dengan invasi limfatik dan metastasis kelenjar getah bening regional pada karsinoma payudara invasif tipe tidak spesifik.

Metode: Penelitian ini menggunakan metode analitik potong lintang dengan sampel 38 blok parafin dari pasien karsinoma payudara invasif tipe tidak spesifik di RSUP Sanglah, Bali, Indonesia tahun 2018. Penilaian LVD dan LVI dengan pulasan imunohistokimia D2-40. Ekspresi D2-40 dengan intensitas yang kuat dievaluasi pada membran dan sitoplasma sel endotel limfatik untuk menetapkan definisi pembuluh limfatik. Lymph vessel density ditentukan dengan menghitung jumlah lumen pembuluh limfatik peritumoral pada lima lapangan pandang yang memiliki lumen pembuluh limfatik terpadat, menggunakan mikroskop Leica (DM750, 400x, luas area 0,225mm²). Data dianalisis dengan SPSS versi 24 untuk Windows.

Hasil: Nilai cut-off LVD adalah 16,5 lumen pembuluh limfatik/0,225 mm² (sensitivitas 65,4% dan Area Under the Curve (AUC)=70,2%). Kemudian kasus dikategorikan menjadi LVD tinggi (?16,5 lumen pembuluh limfatik / 0,225 mm2) dan LVD rendah (<16,5 lumen pembuluh limfatik / 0,225 mm2). Hasil analisis statistik menunjukkan bahwa terdapat hubungan antara LVD dengan invasi limfatik (PR=3,6; p=0,043; IK 95%=0,88-14,78) dan metastasis KGB regional (PR=1,7; p=0,02; IK 95%=1,03-2,79).

Kesimpulan: Penelitian ini membuktikan bahwa terdapat hubungan antara LVD dengan invasi limfatik dan metastasis KGB regional. 

Faktor risiko yang mempengaruhi outcome pada pasien cedera kepala di RSUP Sanglah, Bali, Indonesia pada tahun 2018-2019

Background: Head injury or capitis trauma is a blunt/sharp force to the head or face resulting in temporary or persistent cerebral dysfunction. From a socio-economic point of view, the prognostic model by looking at baseline data on admission is an important factor in supporting cost-effective clinical decisions. This study aims to evaluate the risk factors that influence outcomes in head injury patients at Sanglah Hospital, Bali, Indonesia, in 2018-2019.

Method: Prospective cohort study to see the effect of risk factors for head injury patients (exposure) with the outcome in the form of unfavorable conditions within 7 days. This research was conducted at the Surgery Department and Emergency Room Sanglah Hospital Denpasar- Bali for 6 months from September 2018-February 2019. Data were analyzed using SPSS version 16 for Windows.

Results: Some of the factors significantly associated with and risk factors for the unfavorable outcome within 7 days in head injury patients who were treated at Sanglah General Hospital in 2018-2019 were hypotension, initial GCS 3-8, anisocoria pupil reflex, hypoxia, focal lesions, midline shift, and length of time operation ? 6 hours (p<0.05). Hypotensive blood pressure is the most dominant risk factor for the unfavorable outcome within 7 days of head injury patients admitted to Sanglah General Hospital (Adjusted OR: 5.4; 95% CI: 2.47-12.07; p=0.000).

Conclusion: Hypotensive blood pressure is the most dominant risk factor for the unfavorable outcome within 7 days of head injury patients treated at Sanglah General Hospital in 2018-2019.

Latar belakang: Cedera kepala atau trauma kapitis merupakan kekerasan tumpul/tajam pada kepala atau wajah yang berakibat disfungsi serebral sementara atau menetap. Dari sudut pandang sosioekonomi, model prognostik dengan melihat data awal saat masuk rumah sakit merupakan faktor penting dalam mendukung keputusan klinis yang cost-effective. Penelitian ini bertujuan untuk mengevaluasi faktor risiko yang mempengaruhi outcome pada pasien cedera kepala di RSUP Sanglah, Bali, Indonesia pada tahun 2018-2019

Metode: Studi kohort prospektif untuk melihat pengaruh faktor resiko yang dimiliki pasien cedera kepala (exposure) dengan hasil luaran (outcome) berupa kondisi unfavourable dalam 7 hari. Penelitian ini dilakukan di Bagian Bedah FK UNUD/SMF Bedah Saraf RSUP Sanglah, Denpasar-Bali dan Instalasi Rawat Darurat RS Sanglah Denpasar-Bali selama 6 bulan dari bulan September 2018-Februari 2019. Data dianalisis menggunakan SPSS versi 16 untuk Windows.

Hasil: Beberapa faktor yang berhubungan secara bermakna dan menjadi faktor risiko terjadinya outcome unfavorable dalam 7 hari pada pasien cedera kepala yang dirawat di RSUP Sanglah tahun 2018-2019 adalah hipotensi, GCS awal 3-8, reflek pupil anisokor, hipoksia, fokal lesi, midline shift, dan lama waktu tindakan operasi ? 6 jam (p<0,05). Tekanan darah hipotensi merupakan faktor risiko yang paling dominan terhadap outcome unfavorable dalam 7 hari pasien cedera kepala yang dirawat di RSUP Sanglah (Adjusted OR: 5,4; 95% IK: 2,47-12,07; p=0,000)

Kesimpulan: Tekanan darah hipotensi merupakan faktor risiko yang paling dominan terhadap outcome unfavorable dalam 7 hari pasien cedera kepala yang dirawat di RSUP Sanglah tahun 2018-2019.

Karakteristik malnutrisi rumah sakit pada pasien anak di RSUP Sanglah, Bali, Indonesia

Background: Hospital Malnutrition (HM) is malnutrition diagnosed while being treated at the hospital either when admitted to the hospital, during treatment or even when discharged from the hospital, which is closely related to hospital care. The incidence of HM is still quite high and can increase morbidity and mortality among inpatient children. This study aims to determine the characteristics of in-hospital malnutrition cases in children undergoing treatment at Sanglah Hospital.

Methods: This study used a prospective cohort design using primary data obtained from interviews and anthropometry of 120 children hospitalized at Sanglah Hospital in the 2019-2020 period. HM was defined as a decrease in a Z-score of Weight/Height (W/H) > 0.5 Standard Deviation (SD) at the time of hospital discharge. Data were analyzed using SPSS version 20 for Windows.

Results: The incidence of HM was 47.1%, of which 54.0% of patients were female. The incidence of in-hospital malnutrition was primarily found in patients aged 1-3 years (50.0%) and >5 years (42.0%). Approximately 64.0% of children with HM were malnourished before being admitted to the hospital and 14.0% got parenteral nutrition. It was found that 72% of children with HM had a hospital stay length of > 7 days. More than half of children with HM (56.0%) have parents with low levels of education (less than secondary education) and 58.0% have more than 3 siblings.

Conclusion: The incidence of hospital malnutrition is more often found in girls, age >5 years old, malnutrition before admitted, get parenteral nutrition, had parents with low education levels, number of siblings > 3, had a single diagnosis and length of stay > 7 days. 

Latar Belakang: Malnutrisi rumah sakit (MRS) adalah malnutrisi yang didiagnosis saat dirawat di Rumah Sakit (RS) baik saat masuk RS, selama perawatan atau bahkan saat pasien keluar dari rumah sakit yang erat kaitannya dengan perawatan di RS. Kejadian MRS masih cukup tinggi dan dapat meningkatkan morbiditas dan mortalitas pada anak yang dirawat. Penelitian ini bertujuan untuk mengetahui karakteristik dari kasus MRS pada anak yang menjalani perawatan di RSUP Sanglah.

Metode: Studi ini menggunakan desain kohort prospektif dengan menggunakan data primer dari wawancara dan pemeriksaan antropometri terhadap 120 anak yang dirawat inap di RSUP Sanglah pada periode 2019-2020. MRS didefinisikan sebagai penurunan Z-score Berat Badan/Tinggi Badan (BB/TB) > 0,5 Standard Deviation (SD) pada saat keluar RS. Data dianalisis dengan SPSS versi 25 untuk Windows.

Hasil: Kejadian MRS ditemukan sebanyak 47,1% dengan 54,0% sampel berjenis kelamin perempuan. Insidens MRS paling banyak ditemukan pada pasien kelompok usia 1-3 tahun (50,0%) dan >5 tahun (42,0%). Sebanyak 64,0% anak dengan MRS sudah mengalami malnutrisi sebelum masuk RS dan 14,0% mendapatkan nutrisi parenteral. Ditemukan bahwa 72,0% anak dengan MRS memiliki lama rawat di RS >7 hari. Lebih dari separuh anak dengan MRS (56,0%) memiliki orang tua dengan tingkat pendidikan rendah (<SMP) dan 58,0% memiliki jumlah saudara lebih dari > 3.

Kesimpulan: Insiden MRS lebih sering ditemukan pada anak perempuan, kelompok usia >5 tahun, malnutrisi sebelum masuk RS, mendapatkan nutrisi parenteral, memiliki orang tua dengan tingkat pendidikan rendah, jumlah saudara kandung > 3, serta memiliki diagnosis tunggal serta lama rawat > 7 hari. 

Karakteristik pasien kanker kulit non-melanoma di RSUP Sanglah pada periode tahun 2014 - 2018

Background: Skin cancer is a disease caused by changes in the properties of the constituent skin cells from normal to malignant. There are 3 most common types of skin cancer: Basal Cell Carcinoma (BCC), Squamous Cell Carcinoma (SCC), and malignant melanoma. This study aims to determine the clinicopathological characteristics of non-melanoma skin cancer patients, especially BCC and SCC, at Sanglah General Hospital, Denpasar, in 2014 – 2018.

Methods: This study is a retrospective descriptive study. Clinicopathological data of non-melanoma skin cancer patients were obtained from the histopathological examination archive at the Anatomical Pathology Laboratory of Sanglah General Hospital from 2014 – 2018. Data were analyzed using SPSS version 20 for Windows.

Results: During 2014 – 2018, there were 100 patients with non-melanoma skin cancer at Sanglah Hospital. Based on histopathological type, there were 39 cases (39.0%) of BCC and 61 cases (61.0%) of SCC. BCC was predominant in the age group above 70 years (33.33%) and the highest type of SCC in the age group 50-59 years (32.79%). Based on gender, BCC is more frequent in women by 53.85% and SCC is more frequent in men by 54.10%.

Conclusion: The highest non-melanoma skin cancer cases were SCC with age more than 50 years and were more commonly found in men.

Latar Belakang: Kanker kulit adalah salah satu penyakit yang diakibatkan oleh berubahnya sifat-sifat penyusun sel kulit yang awalnya normal menjadi ganas. Terdapat 3 jenis kanker kulit yang tersering, yaitu Karsinoma Sel Basal (KSB), Karsinoma Sel Skuamosa (KSS), dan melanoma maligna. Tujuan penelitian ini adalah untuk mengetahui karakteristik klinikopatologi pasien kanker kulit non-melanoma khususnya karsinoma sel basal dan karsinoma sel skuamosa di RSUP Sanglah Denpasar pada periode tahun 2014 – 2018.

Metode: Penelitian ini adalah penelitian deskriptif retrospektif. Data klinikopatologi pasien kanker kulit non-melanoma diperoleh dari arsip pemeriksaan histopatologi di Laboratorium Patologi Anatomi RSUP Sanglah Denpasar tahun 2014 – 2018. Data dianalisis dengan SPSS versi 20 untuk Windows.

Hasil: Selama periode tahun 2014 – 2018 terdapat 100 pasien kanker kulit non-melanoma. Berdasarkan tipe histopatologi, terdapat 39 kasus (39,00%) KSB dan 61 kasus (61,00%) KSS. KSB ditemukan terbanyak pada kelompok usia diatas 70 tahun (33,33%) dan tipe KSS terbanyak pada kelompok usia 50-59 tahun (32,79%). Berdasarkan jenis kelamin, KSB lebih banyak pada perempuan sebesar 53,85% dan KSS lebih banyak pada laki – laki sebesar 54,10%.

Kesimpulan: Kasus kanker kulit non-melanoma tertinggi adalah KSS dengan usia lebih dari 50 tahun dan lebih banyak ditemukan pada laki – laki. 

Hubungan ASI eksklusif dengan angka kejadian diare pada anak usia 6 – 24 bulan di RSUD Wangaya

Background: Diarrhea is a gastrointestinal tract disease with the highest incidence rate and the most common cause of death in children under five years old. Based on Riskesdas 2013, the prevalence of diarrhoea in Indonesia is between 1 – 4 years old. Diarrhea is particularly common in developing countries due to inadequate sanitation and hygiene, including a lack of safe, clean water for drinking and a lack of concern for nutrition and overall health. The risk of diarrhoea in children is also influenced by the pattern of breastfeeding. Exclusive breastfeeding in infants is known to protect the babies against diarrhea.

Methods: This is an observational study where the data was collected from inpatient medical records between January – December 2019. This study was conducted analytically using a retrospective cross-sectional design. For sampling, a systematic random sampling technique was used. In this study, univariate analysis was used to get the distribution and the proportion of each variable. The relationship between exclusive breastfeeding and the incidence of diarrhea was analyzed using chi-square. Statistical analysis was performed in a 95% coefficient interval (alpha = 0.05).

Results: Fifty-six patients were enrolled after meeting the inclusion criteria; 58.3% are male. The number of children who had diarrhea was 36 (64.3%), from that number 38.9% are aged 6 to 12 months, and 61.1% are aged 13 to 24 months. Children who have received exclusive breastfeeding were 22 children (39.3%).  There is a relationship between exclusive breastfeeding to the incidence rate of diarrhea in children aged 6-24 months (p= 0.003). To determine the relative risk estimation using prevalence ratio (RP), with the study calculation obtained 0.51 (< 1).

Conclusion: There is a significant relationship between exclusive breastfeeding and the incidence of diarrhea in children aged 6-24 months. The prevalence ratio results in 0.51 it tells that exclusive breastfeeding is a protective factor against diarrhea.

Latar Belakang: Diare adalah salah satu penyakit sistem pencernaan yang memiliki angka kejadian tertinggi dan paling sering menyebabkan kematian pada anak berusia dibawah lima tahun. Faktor risiko diare pada anak juga dipengaruhi oleh pola pemberian ASI eksklusif. ASI eksklusif diketahui memiliki efek perlindungan pada bayi terhadap diare. Penelitian ini bertujuan untuk membuktikan adanya hubungan antara pemberian ASI eksklusif dengan angka kejadian diare pada anak usia 6 – 24 bulan.

Metode: Penelitian ini merupakan penelitian observasional yang mengambil data dari rekam medis pasien anak berusia 6 – 24 bulan yang rawat inap bulan Januari – Desember 2019 di ruang Kaswari RSUD Wangaya. Penelitian ini dilakukan secara analitik menggunakan desain cross-sectional retrospektif. Untuk pengambilan sampel menggunakan cara systematic random sampling. Pengolahan dan analisis data dilakukan secara bertahap yaitu dengan melakukan analisis univariat untuk memperoleh distribusi dan proporsi dari variabel-variabel yang diteliti serta analisis bivariat dengan uji statistik chi-square. Analitik yang dilakukan menggunakan interval kepercayaan 95% (alpha = 0,05).

Hasil: Terdapat lima puluh enam sampel yang memenuhi kriteria inklusi, 58,3% diantaranya adalah laki-laki. Angka kejadian diare yang terjadi pada anak sebanyak 36 (64,3%), dari angka tersebut 38,9% berusia 6 – 12 bulan dan 61,1% berusia 13 – 24 bulan. Anak yang mendapat ASI eksklusif sebanyak 22 anak (39,3%). Dari hasil penelitian ini didapatkan hubungan antara ASI Eksklusif dengan angka kejadian diare pada anak usia 6 – 24 bulan (p = 0,003). Rasio prevalensi pada penelitian ini didapatkan sebesar 0,51 (< 1).

Kesimpulan: Terdapat hubungan yg signifikan antara ASI eksklusif dengan angka kejadian diare pada anak usia 6 – 24 bulan. Dari hasil rasio prevalensi 0,51, menunjukkan bahwa anak yang mendapatkan ASI eksklusif memiliki risiko mengalami diare lebih rendah yaitu 0,51 kali apabila dibandingkan dengan anak yang tidak mendapat ASI eksklusif.

Tuberculosis cases comparison in developed country (Australia) and developing country (Indonesia): a comprehensive review from clinical, epidemiological, and microbiological aspects

Background: Tuberculosis (TB) is one of most crucial public health issues around the world. TB is an entity of a complex disease with the socio-economic aspect that has very strong correlation in regard to combat this disease. Migration from developing country to developed country inevitably possesses big influence on global epidemiologic of TB. In Australia, TB still becomes the main threat not only in native population but also regarding the migrant movement into Australia. Indonesia is one of among the TB endemic countries with high TB cases, in which not merely due to its high TB prevalence and incidence but also influenced by very high and dense population.

Aim: This literature aims to review the clinical, epidemiological, and microbiological aspects of tuberculosis as a comparison between developed country (Australia) and developing country (Indonesia).

Conclusion: Tuberculosis cases in Australia remains low compared to Indonesia, however, the close proximity to adjacent developing countries with high endemic of TB contributes significantly to increase number of TB in Australia. Tuberculosis can be cured by following the treatment guidelines with proper monitoring. Moreover, the collaboration between public and private sector along with active collaboration from the family or people surrounding the patients is required to eliminate TB disease.

Mechanism of action of metformin as an anti-aging agent: a literature review

Aging is a complex process consisting of various mechanisms that can cause damage and decrease the body's extrinsic and intrinsic functions. Metformin has been indicated for the treatment of degenerative diseases. It also has been reported to be used as an anti-aging agent. Various studies reported different mechanisms of action, but human studies are limited. This literature aims to review the multiple mechanisms of action of metformin as an anti-aging agent. Metformin has been reported to exert anti-aging effects by prolonging life in humans and animals. The effectiveness of metformin as an anti-aging agent is influenced by the dosage and age of the subjects studied. Various mechanisms of action of metformin concerning anti-aging have been reported, including autophagy pathways with AMPK activation and inhibition of mTOR, increased antioxidants, inhibition of ROS, inhibition or enhancement of mitochondrial function and inhibition of inflammation. It was found that there were biomarkers in the form of GPx7, Nrf2, PPAR and SREBP, SOD2, TrxR1, NQO1, NQO2, pNF-kB, FOXO, mTOR, AMPK, which could be used as predictors to explain the anti-aging effect of metformin. 

Pencegahan penularan infeksi Human Immunodeficiency Virus (HIV) dari ibu ke anak di Indonesia: sebuah tinjauan pustaka

Human Immunodeficiency Virus (HIV) can be transmitted from an HIV-positive woman to her child during pregnancy, childbirth, and breastfeeding. Mother-to-child transmission (MTCT), also known as ‘vertical transmission’, accounts for the vast majority of infection in children (0-14 years). Prevention of mother-to-child HIV infection transmission (PMTCT) programs offers a range of services for women of reproductive age (15-49 years) living with or at risk of HIV to maintain their health and stop their infants from acquiring HIV. WHO promotes a comprehensive approach to PMTCT programs which include: preventing new HIV infections among women of reproductive age, preventing unintended pregnancies among women living with HIV, preventing HIV transmission from women living with HIV to her baby, and providing appropriate treatment, care, and support to mothers living with HIV, their children, and families. The health service program to prevent HIV transmission from HIV-infected pregnant women to their babies includes the following activities: integrated ANC services, including offering and testing HIV to pregnant women; HIV diagnosis in pregnant women; administering antiretroviral therapy to pregnant women; safe delivery; arrange for subsequent pregnancies; management of feeding for infants and children; administration of Antiretroviral (ARV) prophylaxis and cotrimoxazole in children; HIV diagnostic testing in children; and immunization. The risk of MTCT of HIV can be reduced to less than 2% with optimal PMTCT programs.

Human Immunodeficiency Virus (HIV)  dapat ditularkan dari ibu yang terinfeksi kepada bayi yang dikandung selama kehamilan, persalinan dan menyusui. Penularan infeksi HIV dari ibu kepada bayi yang dikandung, dikenal dengan istilah transmisi vertikal, merupakan cara penularan infeksi tersering dijumpai pada anak usia 0-14 tahun. Program pencegahan penularan infeksi HIV dari ibu ke anak (PPIA) merupakan upaya terhadap perempuan usia produktif (15-49 tahun) yang terinfeksi atau memiliki risiko terinfeksi HIV untuk tetap terjaga kesehatannya, serta mencegah menularkan infeksi HIV kepada bayi yang dikandung. World Health Organization (WHO) mempromosikan upaya komprehensif dari PPIA, terdiri dari: mencegah terjadinya penularan HIV pada perempuan usia reproduksi, mencegah kehamilan yang tidak direncanakan pada perempuan dengan HIV, mencegah terjadinya penularan HIV dari ibu hamil HIV positif ke bayi yang dikandungnya, serta memberikan dukungan psikologis, sosial, dan perawatan kesehatan kepada ibu HIV positif beserta bayi dan keluarganya. Program pelayanan kesehatan untuk mencegah penularan HIV dari ibu hamil terinfeksi HIV kepada bayi yang dikandung mencakup kegiatan sebagai berikut: layanan antenatal care (ANC) terpadu termasuk penawaran dan tes HIV pada ibu hamil; diagnosis HIV pada ibu hamil; pemberian terapi antiretroviral pada ibu hamil; persalinan yang aman; menunda dan mengatur kehamilan berikutnya; tatalaksana pemberian makanan bagi bayi dan anak; pemberian profilaksis Antiretroviral (ARV) dan kotrimoksazol pada anak; pemeriksaan diagnostik HIV pada anak; serta imunisasi. Dengan upaya PPIA yang optimal, risiko penularan HIV dari ibu ke anak dapat diturunkan sampai kurang dari 2%.

Gejala konjungtivitis pada pasien dengan COVID-19: sebuah tinjauan sistematis

Background: Infection of severe acute respiratory coronavirus syndrome 2 (SARS-CoV-2) or Coronavirus disease 2019 (COVID-19) has become a global pandemic. The clinical symptoms are not typical, making clinical diagnosis difficult to do. A number of studies have stated that ocular involvement in the form of conjunctivitis can be one of the symptoms of COVID-19 infection. The purpose of this systematic review is to determine the symptoms of conjunctivitis in patients with COVID-19 infection.

Methods: A systematic literature review was carried out by searching the literature on the Cochrane Library, Pubmed, and Google Scholar, also selecting the literature using the PRISMA diagram. The inclusion criteria used were studies that examined the symptoms of conjunctivitis in COVID-19 patients published in the range of 2020-2021. Studies in the form of editorials, commentaries, reviews or meta-analyses, articles are not available in full-text, not available in English or Indonesian, do not discuss ocular manifestations of COVID-19 infection, or only discuss the detection of the SARS CoV-2 virus in conjunctival secretions. So that there were 12 studies that met the eligibility criteria.

Results: There were 12 studies that carried out synthetic analysis, namely 4 cross-sectional studies, one case-control study, one case series study, and six case reports. The prevalence of conjunctivitis symptoms in COVID-19 infection ranges from 5.04-31.75%. Conjunctivitis is more common in male COVID-19 patients, with mild to moderate symptoms and duration of illness ranging from 5-26 days. Conjunctivitis in COVID-19 patients was reported as an early symptom of COVID-19 infection and the data became the sole symptom of COVID-19 infection. The habit of rubbing the eyes, impaired smell and taste were found to be significantly associated with conjunctivitis symptoms.

Conclusion: Although conjunctivitis is found in only a minority of COVID-19 cases, the conjunctiva can be one of the routes of transmission of COVID-19 infection. The use of goggles and face shields is important as an effort to prevent infection transmission.

Latar Belakang Infeksi severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) atau Coronavirus disease 2019 (COVID-19) telah menjadi pandemi global. Gejala klinisnya yang tidak khas membuat penegakkan diagnosis klinis sulit dilakukan. Sejumlah studi menyebutkan keterlibatan okuler berupa konjungtivitis dapat menjadi salah satu gejala infeksi COVID-19. Tujuan dari systematic review ini adalah untuk mengetahui gejala konjungtivitis pada pasien dengan infeksi COVID-19.

Metode: Tinjauan pustaka sistematis dilakukan dengan pencarian literatur pada Cochrane Library, Pubmed dan Google Scholar, juga pemilihan literatur menggunakan diagram PRISMA. Kriteria inklusi yang digunakan adalah studi yang meneliti gejala konjungtivitis pada pasien COVID-19 yang terpublikasi pada rentang tahun 2020-2021. Studi berupa editorial, commentary, review maupun meta analisis, artikel tidak tersedia secara full-text, tidak tersedia dalam Bahasa Inggris atau Indonesia, tidak membahas manifestasi okuler pada infeksi COVID-19, atau hanya membahas mengenai deteksi virus SARS CoV-2 pada sekresi konjungtiva dilakukan eksklusi sehingga didapatkan 12 studi yang memenuhi kriteria eligibilitas.

Hasil: Terdapat 12 studi yang dilakukan analisis sintesis, yakni 4 studi cross sectional, satu studi kasus kontrol, satu studi serial kasus dan enam laporan kasus. Prevalensi gejala konjungtivitis pada infeksi COVID-19 berkisar 5,04-31,75%. Konjungtivitis lebih banyak ditemukan pada pasien COVID-19 berjenis kelamin laki-laki, dengan gejala ringan sedang dan durasi penyakit berkisar 5-26 hari. Konjungtivitis pada pasien COVID-19 dilaporkan sebagai gejala awal infeksi COVID-19 dan data menjadi gejala tunggal infeksi COVID-19. Kebiasaan menggosok mata, gangguan penciuman dan pengecap ditemukan signifikan berhubungan dengan gejala konjungtivitis.

Simpulan: Meskipun konjungtivitis ditemukan hanya pada sebagian kecil kasus COVID-19, konjungtiva dapat menjadi salah satu rute transmisi infeksi COVID-19. Penggunaan goggles dan face shield penting dilakukan sebagai upaya pencegahan transmisi infeksi.

Glaucoma drainage devices implantation in uveitic glaucoma: a systematic review

Background: Uveitis is broadly defined as inflammation of the uvea. Glaucoma is the third most common complication of uveitis. Uveitic Glaucoma (UG) is known to be refractory, and multiple surgeries are often required for proper treatment. The purpose of this study is to determine the effectiveness of Glaucoma Drainage Device (GDD) implantation as a surgical procedure in UG patients.

Method: We conducted a systematic search of electronic databases from PubMed, Science Direct, and SpringerLink using a combination of relevant keywords was performed by 5 independent reviewers. Various search terms, including 'glaucoma drainage device', 'glaucoma drainage implants', 'glaucoma filtration implants', 'aqueous shunts', 'uveitic glaucoma', 'inflammatory glaucoma'.

Result: A total of 143 articles were retrieved, but only 14 articles were eligible for data extraction. There are 631 eyes from 583 patients who had UG, 442 eyes underwent GDD implantation. Overall, intraocular pressure and the use of glaucoma medication were reduced. Mean IOP preoperative is 31.57 mmHg, and IOP postoperative is 14.48 mmHg. There is a reduction in IOP of an average of 17.09 mmHg. The number of glaucoma medications has decreased from 3.24 to 1.29 postoperatively.

Conclusion: UG has been shown to be managed successfully by GDD implantation. GDD implantation may be considered a long-term effective surgical option for patients with UG.

Diagnosis dan tatalaksana tromboangitis obliterans/penyakit buerger dengan fenomena raynaud

Introduction: Thromboangitis obliterans (TAO) is segmental, non-atherosclerotic inflammatory disease involving small to moderate arteries, veins, and nerves of extremities. TAO or Buerger's disease has very strong association with tobacco use. The adoption of stricter diagnostic criteria and reduced tobacco use have led to a decline in the number of new TAO patients in United States, Europe, and Asia. Typical TAO patients are young men with history of heavy smoking who present with limb ischemic symptoms before age 45 years. The most common symptoms are due to arterial occlusion disease, secondary vasospasm (Raynaud’s phenomenon), and superficial thrombophlebitis. Clinical diagnosis of TAO requires exclusion of diseases that mimic this diseases such as atherosclerotic vascular disease, thromboembolic disease, and autoimmune diseases such as scleroderma. Therapeutic foundation for TAO is complete cessation of any tobacco use. The use of vasodilators is largely for palliative. Therapeutic anticoagulants have not been shown to be effective in the treatment of TAO. Nonetheless, some physicians have used anticoagulants in attempt to delay amputation and increase collateral flow in severe critical limb ischemia.

Case report: A 56 year old man complained of bluish and pain on the finger tips of both right and left hand. Smoking four packs a day. Dupplex ultrasound and CT scan of the superior limb angiography showed no abnormalities in the proximal artery. Echocardiography showed result within normal limit.

Conclusion: These findings suggest diagnosis of thromboangitis obliterans with Raynaud's phenomenon, even if he is over 45 years of age.

Pendahuluan: Tromboangitis obliterans (TAO) adalah penyakit inflamasi nonaterosklerotik segmental yang melibatkan arteri, vena, dan saraf kecil dan sedang pada ekstremitas. TAO atau penyakit Buerger memiliki hubungan yang sangat kuat dengan penggunaan tembakau. Penerapan kriteria diagnostik yang lebih ketat dan pengurangan penggunaan tembakau telah menyebabkan penurunan jumlah pasien baru TAO di Amerika Serikat, Eropa, dan Asia. Tipikal pasien TAO adalah pria muda dengan riwayat perokok berat yang muncul dengan gejala iskemik ekstremitas sebelum usia 45 tahun. Gejala paling umum akibat penyakit oklusi arteri, vasospasme sekunder (fenomena Raynaud), dan tromboflebitis superfisial. Diagnosis klinis TAO membutuhkan eksklusi penyakit yang menyerupai penyakit tersebut seperti penyakit pembuluh darah aterosklerotik, penyakit tromboemboli, dan penyakit autoimun seperti scleroderma. Landasan terapi untuk TAO adalah penghentian total setiap penggunaan tembakau. Penggunaan vasodilator pada pasien dengan TAO sebagian besar bersifat paliatif. Antikoagulan terapeutik belum pernah terbukti secara efektif dalam pengobatan TAO. Meskipun demikian, beberapa dokter telah menggunakan antikoagulan dalam upaya untuk menunda amputasi dan meningkatkan aliran kolateral pada iskemia ekstremitas kritis yang berat.

Laporan kasus: Seorang laki-laki berusia 56 tahun mengeluh kebiruan dan nyeri pada ujung kedua jari tangan kanan dan kiri. Merokok empat bungkus sehari. Temuan dupplex ultrasound dan CT scan angiografi ekstremitas superior menunjukkan tidak ditemukan kelainan pada arteri proksimal. Pemeriksaan ekokardiografi juga menunjukkan hasil dalam batas normal.

Simpulan: Dari temuan-temuan tersebut mengarahkan diagnosis pasien dengan tromboangitis obliterans dengan fenomena Raynaud, walaupun usia sudah lebih dari 45 tahun.

Pansinusitis kronis dengan komplikasi abses serebri dan selulitis preseptal: laporan kasus

Background: Rhinosinusitis is an inflammation of the sinuses of the paranasal mucosa, while pansinusitis is an inflammatory process in several sinuses. Rhinosinusitis is one of the most prevalent health problems in the world. Although rare, rhinosinusitis can also lead to serious complications, including intracranial complications such as a cerebral abscess. This case report attempts to evaluate a cerebral abscess and preseptal cellulitis caused by chronic pansinusitis.

Case Presentation: A 56 years old woman, after trepanation, was consulted by the neurosurgery department to the ear, nose, throat, head, and neck department at dr. Saiful Anwar Hospital. Patients with complaints of decreased consciousness. A gradual decrease in consciousness was felt 3 weeks before admission to the hospital (SMRS). CT scan showed a cerebral abscess with a single lesion located in the frontal (unilocular) lobe as a complication of chronic pansinusitis. In this case, there was also preseptal cellulitis due to the spread of infection from the ethmoid sinus to the orbit. Treatment with ceftriaxone, metronidazole, omeprazole, ketorolac, Levemir, Apidra, Levocin, and anterior ethmoidectomy showed clinical improvement.

Conclusion: Cerebral abscess is a rare complication of chronic pansinusitis but has a high morbidity and mortality rate. Medical intervention and anterior ethmoidectomy showed clinical improvement in patients.

Latar Belakang: Rinosinusitis adalah peradangan sinus mukosa paranasal sedangkan pansinusitis merupakan proses inflamasi pada beberapa sinus. Rinosinusitis adalah salah satu masalah kesehatan yang memiliki prevalensi besar di dunia. Meskipun jarang terjadi, rinosinusitis juga dapat mengakibatkan komplikasi serius termasuk komplikasi intrakranial seperti abses serebri. Laporan kasus ini berupaya untuk mengevaluasi abses serebri dan selulitis preseptal yang disebabkan oleh pansinusitis kronis.

Presentasi Kasus: Seorang wanita berusia 56 tahun pasca trepanasi dikonsultasikan oleh departemen bedah saraf ke departemen telinga hidung tenggorok kepala leher (THT-KL) RSUD dr. Saiful Anwar Pasien dengan keluhan terjadi penurunan kesadaran. Penurunan kesadaran secara gradual dirasakan semenjak 3 minggu sebelum masuk rumah sakit (SMRS). Pemeriksaan CT-Scan menunjukkan keberadaan abses serebri dengan lesi tunggal yang terletak pada lobus frontalis (unilokuler) sebagai komplikasi pansinusitis kronis. Pada kasus ini juga didapatkan selulitis preseptal akibat penyebaran infeksi dari sinus ethmoidalis ke orbita. Pengobatan dengan pemberian ceftriaxone, metronidazole, omeprazole, ketorolac, Levemir, Apidra, Levocin, dan etmoidektomi anterior menunjukkan perbaikan klinis.

Kesimpulan: Abses serebri adalah komplikasi yang jarang pada pansinusitis kronis tetapi memiliki angka morbiditas dan mortalitas yang tinggi. Intervensi medikamentosa dan etmoidektomi anterior menunjukkan perbaikan klinis pada pasien.

Acute Decompensated Heart Failure (ADHF) with aortic dissection Stanford A in middle aged man: a case report

Background: Heart failure is a clinical syndrome with shortness of breath, fluid retention, and the heart's structural and functional disorder. Each year, there were 7,2 cases every 1000 people on male and 4,7 cases every 1000 people on the female. Aortic dissection is an emergency disease in which the symptoms are similar to ischemic heart disease, that 38% of patients got misdiagnosed on the first evaluations. Because of the clinical course of heart failure and misdiagnosed aortic dissection that frequently happened, authors are interested in making a case report with both conditions.

Case report: A male patient, 39 years old, complained of shortness of breath and epigastrium pain. The patient was diagnosed with Acute Decompensated Heart Failure (ADHF) profile B with emergency hypertension and suspected aortic dissection based on history and physical examination. The patient was also diagnosed with acute kidney injury stage 1. CT angiography showed widening of the aorta ascending until arcus aorta with a Stanford type A aortic dissection diagnosis.

Conclusion: The condition of aortic dissection can coincide with acute heart failure. Therefore, a clinician must be aware of the emergency of dissection and know the initial symptoms of dissection. The typical clinical symptoms of dissection lead us to perform imaging studies that ultimately lead to a thoracoabdominal CTA to diagnose the dissection.

Disseminated Intravascular Coagulation (DIC) akibat gigitan ular: laporan kasus

Background: Snakebite cases are cases of emergency that are often found in the Emergency Unit, especially in rice fields, forests, plantations and swamps. There is no definitive data on the number of snakebite cases in Indonesia. Morbidity and mortality of snakebite cases are highly dependent on the type of snake species, the number and type of can that enter the body, as well as the availability of anti-snake serum.In these patients were found Disseminated Intravascular Coagulation (DIC) due to snake bites.

Case Presentation: A 5-years female patient complained of pain in the right hand due to snakebite about 30 minutes before entering the hospital. The snake is green with a red tail, a triangular head shape and a length of about 30 centimeters, biting the middle finger of the patient's right hand. Swollen redness and pain are felt spreading to the shoulders. Physical examination of compos mentis patients with a pulse rate of 96 times per minute, breath rate of 20 times per minute and temperature of 36.7^oC. There was found edema and bullae in digiti III in the right manus region, palpably warm, and there is press pain. In the antebrachial region to the right humerus also found the presence of edema and press pain. Patients with normochromic normositer anemia with thrombocytopenia as well as lengthening of coagulation physiology decreased fibrinogen and increased D-dimer.

Conclusion: Snake venom can be hemotoxic, neurotoxic and cytotoxic. Snakebite cases require rapid and comprehensive management to minimize the possibility of disability and death.

Latar Belakang: Kasus gigitan ular merupakan kasus kegawatan yang sering dijumpai di Unit Gawat Darurat terutama di daerah area persawahan, hutan, perkebunan dan rawa. Tidak ada data yang pasti mengenai jumlah kasus gigitan ular di Indonesia. Morbiditas dan mortalitas kasus gigitan ular sangat tergantung dari jenis spesies ular, jumlah dan jenis bisa yang masuk ke dalam tubuh serta ketersediaan serum anti bisa ular.

Presentasi Kasus: Pada pasien ini ditemukan Disseminated Intravascular Coagulation (DIC) akibat gigitan ular. Pasien perempuan, usia 5 tahun dengan keluhan nyeri pada tangan kanan akibat gigitan ular sejak sekitar 30 menit sebelum masuk rumah sakit. Ular berwarna hijau dengan ekor merah, bentuk kepala segitiga dan panjang sekitar 30 centimeter, menggigit jari tengah tangan kanan pasien. Bengkak kemerahan dan nyeri dirasakan menjalar sampai ke bahu. Pemeriksaan fisik pasien compos mentis dengan laju nadi 96 kali per menit, laju nafas 20 kali per menit dan suhu 36,7^oC. Pada regio manus kanan ditemukan adanya edema dan bullae pada digiti III, teraba hangat dan terdapat nyeri tekan. Pada region antebrachii sampai humerus kanan juga ditemukan adanya edema dan nyeri tekan. Pasien mengalami anemia normokromik normositer dengan trombositopenia serta pemanjangan faal koagulasi, penurunan fibrinogen dan peningkatan D-dimer.

Kesimpulan: Bisa ular dapat bersifat hemotoksik, neurotoksik dan sitotoksik. Kasus gigitan ular memerlukan penatalaksanaan yang cepat dan komprehensif sehingga dapat meminimalkan kemungkinan kecacatan dan kematian.

Manajemen multidisiplin Oral Squamous Cell Carcinoma (OSCC): laporan kasus

Background: Oral squamous cell carcinoma (OSCC) is the most common type of oral cancer and represents more than 90% of all head and neck cancers. The etiology of OSCC is multifactorial. The uses of tobacco, heavy alcohol drinking, less consumption of vegetables and fruit, genetics, trauma and viruses are considered possible risk factors of the OSCC. This case study aims to evaluate the multidiscipline management of OSCC at Universitas Airlangga Dental and Oral Hospital, Surabaya, Indonesia.

Case Presentation: This case report presents a 45-year-old female patient who came with chief complaints of ulcer on the lateral right of the tongue that persistent for 3 months ago. The patient also complained of pain when speaking, eating, swallowing, and the pain felt into the right head. The patient has no history of tobacco and alcohol consumption, but her sister has a history of breast cancer. No extraoral abnormalities were found. Intraoral examination results showed a single ulcer with induration on the lateral dextra of the tongue and diffuse pseudomembranous on the dorsal of the tongue. Based on history taking and clinical examination, the patient was suspected of OSCC. The management included debridement of the lesion, complete blood count, fasting blood glucose, HbA1c, and anatomical pathology examination. The patient has also been prescribed anesthetics, antiinflammation and antiseptic mouthwash. The patient was then referred to the head and neck oncologist for hemiglossectomy. Two months after the surgery, there is no complaint of the lateral right of the tongue. The patient also has no complaint about eating and swallowing.

Conclusion: The dentist plays an important role in identifying OSCC. The early diagnosis and proper multidisciplinary management of OSCC could improve the prognosis of the case and the patient's life quality.

Latar belakang: Oral squamous cell carcinoma (OSCC) adalah jenis kanker mulut yang paling umum dan ditemukan hampir pada 90% dari semua kasus karsinoma di rongga mulut. Etiologi OSCC adalah multifaktorial. Penggunaan tembakau, konsumsi alkohol berlebihan, konsumsi sayur dan buah yang lebih sedikit, genetika, trauma dan virus dianggap sebagai faktor risiko OSCC. Laporan kasus ini bertujuan untuk mengevaluasi manajemen multidisipin OSCC pada Rumah Sakit Gigi dan Mulut (RSGM) Universitas Airlangga, Surabaya, Indonesia.

Presentasi Kasus: laporan kasus ini menyajikan kasus seorang pasien wanita berusia 45 tahun yang datang dengan keluhan utama ulserasi pada lateral lidah kanan yang menetap sejak 3 bulan yang lalu. Pasien juga mengeluh nyeri saat berbicara, makan, menelan dan nyeri terasa di kepala kanan. Pasien tidak memiliki riwayat konsumsi tembakau dan alkohol tetapi saudara perempuannya memiliki riwayat kanker payudara. Tidak ditemukan kelainan ekstraoral. Hasil pemeriksaan intraoral menunjukkan ulser tunggal dengan indurasi pada lateral lidah dekstra dan pseudomembran difus pada dorsal lidah. Berdasarkan anamnesis dan pemeriksaan klinis, diagnosa sementara adalah OSCC. Penatalaksanaan meliputi debridement lesi, hitung darah lengkap, glukosa darah puasa, HbA1c, dan pemeriksaan patologi anatomi. Pasien juga diresepkan obat kumur anestetikum, antiinflamasi dan antiseptik. Pasien kemudian dirujuk ke Departemen Bedah Onkologi Kepala Leher untuk dilakukan hemiglosektomi. Dua bulan setelah operasi, tidak ada keluhan pada lidah pasien. Pasien juga tidak memiliki keluhan saat makan dan menelan.

Simpulan: Dokter gigi memiliki peran yang penting dalam mengidentifikasi OSCC. Diagnosis dini dan manajemen multidisplin tepat dapat meningkatkan prognosis kasus dan kualitas hidup pasien.